STATE OF HORMONE HOMEOSTASIS IN PREGNANT WOMEN WITH PLACENTA DYSFUNCTION

Abstract

SUMMARY. Violation of the structural and functional organization of the placenta is one of the leading causes of maternal and perinatal morbidity and mortality, according to various authors, its frequency varies from 10 % to 25 % among all pregnancies. A special place among these causes is occupied by post-covid syndrome and long-covid in pregnant women. Hormonal homeostasis, which is ensured by the close interaction of the hypothalamic-pituitary-ovarian and fetoplacental systems, plays a key role in maintaining pregnancy, ensuring normal fetal development and adapting the maternal organism to growing needs.

The aim – to study the state of the fetoplacental complex in pregnant women based on the study of hormonal homeostasis.

Material and Methods. We observed 110 pregnant women who were divided into three groups. Group I included 25 pregnant women with diagnosed placental dysfunction and fetal growth retardation (FGR) – estimated fetal weight less than the 10th percentile for this gestational age according to fetometry. Group II included 30 pregnant women with diagnosed placental dysfunction without fetal growth retardation with an increase in the resistance index (RI) and/or pulsatility index (PI) in the uterine arteries and/or umbilical artery according to Dopplerometry, which exceeded the 95th percentile for this gestational age. Group III included 30 pregnant women with placental dysfunction and post-covid syndrome (suffered coronavirus disease during pregnancy). Control group: 25 pregnant women with a physiological course of pregnancy without signs of obstetric complications. The following placental hormones were determined: progesterone (PG, nmol/l), estradiol (pmol/l), human placental lactogen (PL, mg/l), human chorionic gonadotropin (beta-hCG, mIU/ml).

Statistical processing of the obtained data was carried out using Microsoft Excel spreadsheets and Statistica 10.0 software.

Results. When examining pregnant women, the level of hCG in groups I, II and III was significantly lower than in the control. And at the same time, in the group of pregnant women with placental dysfunction and fetal growth retardation syndrome, it turned out to be the lowest compared to pregnant women in groups II and III. The concentration of PL at 32–34 weeks of pregnancy with fetal growth retardation on the background of placental dysfunction was almost 2 times lower than in the control, while in group II the level of PL was 1.6 times, and in group III – 1.8 times than in the control. Analyzing the obtained data on estriol, it can be noted that in group I this indicator was only 57 % of the control indicator, while in group II it was 78 % and in group III only 65 %, (P<0.05). Thus, at 32-34 weeks of pregnancy in the control group, the estriol level was 116.44±1.22 pmol/l, in group I – 66.02±1.06 pmol/l, (P<0.05), in group II – 91.46±1.84 pmol/l, (P<0.05) and 76.32±2.43 pmol/l in group III, which significantly differed from both group II and the control group. A similar trend was observed in the indicators of hCG and estriol. Similar dynamics were observed in group III. Thus, the indicators of PG in groups II and III were 76 % and 80 % of the values of the control group, (P<0.05).

Conclusions. In pregnant women with placental dysfunction, statistically significant changes in the levels of progesterone, estradiol and placental lactogen are observed, which progress with the development of severe complications. Combined analysis of levels of (hCG, PL and estradiol can serve as a diagnostic criterion for an objective assessment of the condition of the fetus and allows to increase the accuracy of predicting the development of placental dysfunction and perinatal complications. Post-covid syndrome is one of the multifactorial causes of placental insufficiency and is accompanied by disorders in the hormone-producing function of the placenta.